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G0289 ?

  1. Default G0289 ?
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    I have a Medicare patient that had left knee arthroscopy with loose body removal and chondroplasty in the medial femoral condyle. From the op report it appears to be removed from the same compartment. I'm looking at CPT code 29877 for the procedure but since this is a Medicare patient & no other procedure was performed in a different compartment do I use 29877? I have had 29877 denied by Medicare as not recognizing 29877. Has anyone else had this problem & do you have any suggestions for me? Can the G0289 only be used when another arthroscopic procedure is done on the same knee/different compartment?

    Thank you
    Jody

  2. Default
    Quote Originally Posted by Jody Hecht View Post
    I have a Medicare patient that had left knee arthroscopy with loose body removal and chondroplasty in the medial femoral condyle. From the op report it appears to be removed from the same compartment. I'm looking at CPT code 29877 for the procedure but since this is a Medicare patient & no other procedure was performed in a different compartment do I use 29877? I have had 29877 denied by Medicare as not recognizing 29877. Has anyone else had this problem & do you have any suggestions for me? Can the G0289 only be used when another arthroscopic procedure is done on the same knee/different compartment?

    Thank you
    Jody
    According to a seminar I went to presented by Mary LeGrand, it says per Medicare rules, G0289 replaces CPT codes 29874, 29877. And G0289 is considered an add on code so you would need another Arthroscopic procedure done in a separate compartment to use that. So in this case I would just code this one as 29877 because it was done in the same compartment and you can only use that code once.
    Different rules apply to private payors. Report services to private payors per CPT rules unless instructed otherwise.

  3. Default
    send G0289 only, as you have already stated medicare does not recognize 29877

  4. #4
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    The 29877 is most often used in conjunction with the 29881 or 29880, and CCI has bundled the 29877 with these and said it is a non modifieable edit. CMS then has the G0289 for Chondroplasty in separate compartment for when documentation will support this. Also this code may used at the discretion of other carriers. However when the only procedure perfored is the 29877 then that is the code you use even with Medicare, they do recognize it just not when presented with other arthroscopic knee codes as it is bundled.

  5. #5
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    Quote Originally Posted by steps2codes View Post
    send G0289 only, as you have already stated medicare does not recognize 29877
    I respectfully disagree. G0289 is an add on code and is not a "stand alone" procedure code.

    Medicare does recognize 29877 when it is coded and billed by itself with no other arthroscopic procedures.

    If for some reason your carrier is not recognizing it, you should appeal this as this clearly defined in the NCCI.

    Mary, CPC, COSC

  6. Default
    Mary:
    you are so right, i was reading 2009 advanced coding education guide for orthopaedics. the funny thing is I have been getting paid for them, or better yet should i say scary thing? thank you so much for your clarification

  7. Default Thank You
    Thanks to all who have responded.

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